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The influence of tumour site on prognosis in metastatic colorectal carcinomas with primary tumour resection

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Abstract

Purpose

The aim of our study was to compare the characteristics and prognosis between right- and left-sided metastatic colorectal carcinomas.

Methods

Data from 937 patients with stage IV colorectal carcinomas (synchronous distant metastasis) who had a resection of the primary tumour between 1985 and 2014 were analysed. Carcinomas in the caecum to transverse colon were defined as right-sided (n = 250; 26.7%). They were compared to tumours located from the splenic flexure to the rectum categorised as left-sided (n = 687; 73.3%).

Results

In right-sided carcinomas, we observed significantly more female patients (50.8 vs 36.2%; p < 0.001), more unfavourable histological types (24.0 vs 8.6%; p < 0.001), more M1c carcinomas (metastases to the peritoneum ± others; 32.0 vs 14.4%; p < 0.001) and more emergencies (11.6 vs 7.1%; p = 0.029), while multimodal treatment was utilised in fewer patients (51.6 vs 63.8%; p = 0.001) and curative resections were less frequently (24.1 vs 35.4%; p = 0.002). Prognosis was significantly worse in patients with right-sided carcinomas (2-year-survival 27.2 vs 44.6%, p < 0.01). This difference was more pronounced after R2 resection (15.3 vs 29.7%; p < 0.001), than after macroscopic curative resection (2-year-survival 63.9 vs 71.9%; p = 0.106). In multivariate Cox regression analysis, tumour site was found to be an independent prognostic factor for overall survival (HR 1.2; 95% CI 1.0–1.5; p = 0.012). During the three 10-year periods, the prognosis improved equally in patients with right- and left-sided carcinomas, while the differences in survival remained identical.

Conclusions

In a surgical patient cohort undergoing primary tumour resection, significant differences in prognosis were observed between patients with metastatic right- and left-sided colorectal carcinomas.

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Authors and Affiliations

  1. Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Susanne Merkel, Vera S. Schellerer, Jonas Göhl, Werner Hohenberger, Klaus Weber & Robert Grützmann

  2. Department of Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany

    Susanne Merkel

  3. Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Axel Wein

  4. Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Sabine Semrau

  5. Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Carol Geppert

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Correspondence to Susanne Merkel.

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Merkel, S., Schellerer, V.S., Wein, A. et al. The influence of tumour site on prognosis in metastatic colorectal carcinomas with primary tumour resection. Int J Colorectal Dis 33, 1215–1223 (2018). https://doi.org/10.1007/s00384-018-3098-3

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